SLEEPY TIMES MESSAGE FROM THE CHAIRMAN -SCOTT T. REEVES, MD, MBA. a DEPARTMENT OF ANESTHESIA AND PERIOPERATIVE MEDICINE

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1 DEPARTMENT OF ANESTHESIA AND PERIOPERATIVE MEDICINE VOLUME 6, ISSUE 2 FEBRUARY 2012 Special Points of Interest Research Strategic Plan National Nurse Anesthetist Week! Pediatric Anesthesia Mission Statement Two Teacher of the Month Nominees! Three new members to the department! Faculty/Resident Bowling Competition I Hung the Moon! Inside this issue: Research Strategic Plan 2-4 Research Faculty Publications National Nurse Anesthetist Week Pediatric Anesthesia Mission Statement Department Excellence 8 Three New Faces! 9 MESSAGE FROM THE CHAIRMAN -SCOTT T. REEVES, MD, MBA Recently, I had the opportunity to attend the retirement party over at ART of one of my mentors, Adell Bell. Adell had been the chief adult cardiac sonographer for the 20 years I have been at MUSC. She was instrumental in teaching me transthoracic echocardiography in 1994, and our friendship continues to this day. Yes, she put up with me almost every day for 12 months while I painstakingly learned cardiac echo anatomy and valvular function. We reminisced on how I would come over after ICU rounds and read echos with Dr. Bruce Usher on video tapes. If we had a question regarding whether a patient s examination had changed from a previous report, we would have to pull the old tape from the warehouse which took several days in order to compare the studies. A lot has changed in the field over the past 20 years. Echo is now considered a routine part of cardiac anesthesiology and an integral component of surgical decision making. This was definitely not the case in the early 90 s. Now there are multiple textbooks on the subject of transesophageal echocardiography and a board certification examination in both advanced and basic perioperative echocardiography administered by the National Board of Echocardiography. The American Society of Echocardiography even has a Council on Perioperative Echocardiography (COPE), and TEE training is a critical part of both Cardiac Anesthesiology and Critical Care Medicine fellowships. As the department works on a faculty mentoring program, it was nice to be able to remember the wonderful mentors I had, including Adell Bell, Dr. Bruce Usher and Dr. Mike Zile (who taught me everything I know about how to write a manuscript) from another department s division of Cardiology. These three were willing to take an interest in a young faculty member from anesthesiology, and I am forever grateful that my career has been greatly enriched because of them. I pray that all junior faculty can identify senior faculty mentors who are willing to give selflessly to the development of our next generation. CT Division Learns 3D Echo 10 REDCap Database 11 Chairmen Changing Sides? 11 Basic PTEeXAM Update 11 Faculty Resident Bowling Competition 12 Grand Rounds 13 I Hung the Moon 14 Dr. Reeves with Adell Bell

2 PAGE 2 RESEARCH CORNER: STRATEGIC PLAN BY: FRANK MCGOWAN, ON BEHALF OF COMMITTEE MEMBERS JAKE ABERNATHY, JEFF BORKHARDT, ALAN FINLEY, CORY FURSE, LATHA HEBBAR, JERRY REVES, AND JOHN SCHAEFER, AND RESEARCH OFFICE STAFF BETH GLADDEN AND PEGGY EDGERTON Mission: The research mission of the Department of Anesthesia and Perioperative Medicine at the Medical University of South Carolina is to pursue excellence and develop new knowledge in areas relevant to perioperative medicine by conducting clinical, translational and basic science research. We seek to better understand disease and pain mechanisms that occur during the perioperative period and severe illness and thereby identify novel and innovative therapeutic targets, technologies, and other strategies that will improve the care and outcome of patients who require perioperative, critical care, and pain treatment. The rationale for pursuing an aggressive research agenda is based upon the need to create--and the intrinsic value of creating-- new knowledge, in order to make enduring contributions to society. In addition, this program is based upon the principle that generating meaningful new knowledge is perhaps the best methods to increase professional and personal satisfaction, enhance professional standing and that of the Department and University, and drive the future of the specialty Overall Strategy: Organized conceptually as an integrated center whose overall purpose is to improve perioperative and longterm outcomes following surgery and intensive care. Capitalize on existing areas of strength: ongoing efforts that address issues related to improving patient outcome will be expanded Develop key new areas aligned with Departmental and COM strengths Integrate and try to leverage with COM s Research Strategic Plan (Genetics/Genomic Medicine, Population Science, and Public Health) Anticipated target areas include: Novel and improved therapies for acute and chronic pain Molecular, cell, and genetic biology of injury, cellular stress responses, and wound healing Pathobiology and treatment of inflammation and blood loss Cell-based therapies to restore damaged organ function Human factors research, innovative operating room and intensive care unit design and management Uses of medical simulation to improve patient safety and clinician education Key programmatic elements include: Protected time, project funds (starter-type grants) Formalized, transparent application and award process Patient enrollment, data collection, IRB, funds management assistance (for extramural awards) by dedicated support staff Statistical consultation and collaboration (10% effort initially Dr. Beth Wolf) Monthly research conference to review project ideas, methods, data collection and analysis, present new techniques and resources, etc. Establish research pods for mentoring and oversight, as well as to develop a community of researchers whose sum is larger than the individual parts

3 PAGE 3 RESEARCH CORNER: STRATEGIC PLAN Some Preliminary Considerations When Planning a New Project: Have you and all co-investigators to be included on the protocol completed the required CITI course through the IRB? What problem are you trying to address? What is your hypothesis? Has this question been addressed before? If so, how is your study different and likely to lead to new and/or different knowledge? Do a thorough literature search; summarize and save results. You will need them for this application, the IRB process, and future publication. What new information will this project generate: for example, how will it help advance the field, improve (or change) existing paradigms, create new ones, improve patient care, etc.? What is the most appropriate method to address this problem (study design)? Is it a chart review or pilot study (e.g. essentially no prior information about the problem or therapy), randomized controlled trial, etc.? What is your primary outcome or response variable? What are secondary outcome variables? If your goal is to examine an effect or outcome, compare 2 or more approaches or therapies, etc. What do you estimate the clinically significant result or difference to be? What is this estimate based on (e.g. clinical practice, published literature)? What types of data will be collected and how will it be analyzed? Are there sufficient numbers of patients and/or procedures of the type required? Should a power analysis be included? If informed consent is required, what is the likely consent rate given the kinds of patients and required study procedures? Are the patients other physicians (e.g. surgeons, intensivists) involved as co-investigators? If not, have they reviewed and agreed to cooperate? If a drug or device study, has the drug or device been FDA-approved for this (or any other) use? Is an IND or IDE from the FDA likely to be necessary (McGowan can help with this question)? Discuss with a senior faculty member, advisor, and/or mentor to help address questions of novelty, study design, etc. What resources will you need to complete the project (Budget)? Include your time, that of other key personnel (e.g. data coordinators, significant statistical collaboration), any equipment and/or supplies that need to be purchased, costs of services that need to be purchased (clinical laboratory tests, pharmacy charges [e.g. blinded dispensing], etc.)

4 PAGE 4 RESEARCH CORNER: PROCESS SUMMARY Idea/Problem Literature Search Mentor, Colleagues Hypothesis Complete Departmental Application, Preliminary Budget Initial Statistical Consultation Prepare Study Outline & Discuss w/mcgowan Research Committee Review, Present at Research Conference Funding Approved Perform Study, Collect Data Prepare Publication Present at Research Data Analysis FACULTY PUBLICATIONS: AS SEEN IN CASE REPORTS IN TRANSPLANTATION

5 PAGE 5 NATIONAL NURSE ANESTHETISTS WEEK, JANUARY BY: THERESA MORGAN, CRNA National Nurse Anesthetists Week (NNAW) is celebrated each year in January. This year was a pleasure as the CRNAs in the Main Hospital not only promoted NNAW but also gave back to an incredible cause. We CRNAs are thankful for the position we have which enables us to take care of our patients with a safe anesthetic and an incredible team of co-workers! The MUSC CRNAs provided education in the form of pamphlets, table tents, posters, and an anesthesia machine set up on the first floor near Starbuck s. The ART CRNAs had their anesthesia machine set up on the ART first floor near the cafeteria. We had a DVD clip displayed on the communication boards at all three sites, Rutledge Tower, ART, and the Main Hospital! A bake sale enticed passersby to learn more about anesthesia as well as donating for a cause close to our department s hearts. The CRNAs chose to donate all the proceeds from the bake sale to The Journey House, a home with the vision of creating a welcome place for families with children having life-changing illnesses. More info can be found at www. TheJourneyHouse.org. In addition, information about The Journey House, an sign up and a poster was offered to quench everyone s curiosity! The bakes goods included amazing and yummy treats. There were cupcakes, muffins, cookies, brownies, scones all packaged individually and with a sticker on each one to give the public a snapshot of who a CRNA is or what we do. A total of $255 was raised for The Journey House. Gratifyingly, many people who stopped at the table gave their donation without even taking a baked good! Many thanks to all the who supported this special week through donations, baking, helping to put up the display table and anesthesia machine (twice, right Larry?), and for putting on a smiling face to greet our many interested and generous customers! Such a success in many ways! In addition, we are thankful for the tasty luncheon which was provided by the Anesthesia Department! Thank you! Let s do it again next year! Left: ART CRNAs Tim McAdams and Amy King Right: CRNAs at the Main Hospital enjoying lunch Left: ART CRNAs along with faculty enjoy lunch Right: Rutledge Tower CRNAs pose for a picture Left: Main Hospital CRNA Theresa Morgan with one of the CRNA students. Right: Dr. Reeves makes an appearance during the CRNA luncheon in the Main Hospital

6 PAGE 6 MUSC DIVISION OF PEDIATRIC ANESTHESIA: MISSION STATEMENT From left to right: Ilka Theruvath, Scott Walton, Scott Reeves, Frank McGowan, Marc Hassid, Michelle Rovner, Amanda Redding. Not Pictures: Cal Alpert, Melinda Bailey, Jake Freely, Cory Furse, Frank Stewart Mission: The mission of the Division of Pediatric Anesthesia is to strive for and promote excellence, innovation, and continuous improvement in the care of children undergoing surgery and non-surgical procedures. Education of current and future providers, development of new knowledge through clinical, translational, and basic research, and advocacy for patients and families are integral components of this mission. Our Core Values: We believe that: 1) Patients and their families always come first; 2) Infants, children, and adolescents deserve care of the highest quality; this includes being cared for by highly dedicated professionals who have specific training and experience to do so; 3) Close collaboration with all members of the health care team is central to the delivery of excellent, safe, and efficient patient care; 4) Hiring and retaining the best staff, maintaining an outstanding work environment, and promoting appropriate work-life balance are also essential to accomplishing our mission. In addition, we recognize that we must be able to adapt, grow, and respond to rapid and at times disruptive changes in health care if we are going to be able to carry out our mission and practice according to our expressed values. Maintaining the status quo will not be sufficient. Instead, we need to effect continuous improvement in the quality, safety, and scope of care that we provide in order to increase the importance and value of our abilities and services to our patients and their families, and to the medical center. The central organizing concept for these activities is "...continuous improvement in the quality, safety, and scope of care that we provide...". To do this, we will need to not only advance our practice in the operating rooms and procedure areas, but also carry it into areas such as preoperative assessment and optimization, coordination of multiple procedures and complex care and, increasingly, postoperative care (including but not limited to pain management). To put it simply, the only acceptable response to a request for our services should be "Yes". In addition, we will need to actively investigate and implement ways that we can not only improve care but decrease complications, speed recovery and reduce length of stay, and reduce costs. Failure to embrace and accomplish these goals will have a negative impact on patient care and also on our future.

7 PAGE 7 MUSC DIVISION OF PEDIATRIC ANESTHESIA: MISSION STATEMENT Specific activities will include: 1) Re-design and implementation of the preoperative assessment process, for "routine" outpatients as well as a mechanism for "high-risk" consultation on both outpatients and inpatients, coordination of multiple services and procedures, etc. We will also investigate the use of new technologies such as patient portals, telemedicine, etc. to improve the efficiency and efficacy of this process. 2) Continue to expand the availability of pediatric anesthesia services for non-or activities such as procedural sedation, diagnostic imaging, etc. 3) Expand the age of coverage of children by pediatric anesthesiologists 4) Increase acute pain management services and capabilities--initially via regional anesthetic and catheterbased techniques for surgery and post-op pain management. Longer term, we will need to increase our involvement in postoperative pain management in general and PCA in particular. 5) Pursue ways to use our unique knowledge about pediatric diseases and pathophysiology, pediatric surgical procedures, perioperative management, pain management, etc. to improve postoperative care while reducing length of stay, complications, and costs. In short, we need to become perioperative hospitalists and develop the skills and relationships necessary to expand the care we provide to the inpatient floors. 6) Examine the need for chronic pain services and ways to be able to provide it in an effective, comprehensive, and financially viable manner. 7) Continue the development of the "virtual" pediatric operating room in preparation for the creation of a dedicated children's facility. These activities include fostering pediatric OR MD and nursing teams, dedicated pediatric intake and recovery areas and staff, pediatric-specific scheduling, daily management of pediatric OR and procedural services by a pediatric anesthesiologist DOD, etc. 8) Actively educate parents, outside physicians, etc. about the value and role of pediatric anesthesiologists. This will be done via our own efforts such as websites, etc. as well as in conjunction with MUSC Children's Hospital marketing efforts. Dr. Jake Freely alongside former Resident Wes Hudson (now Cardiothoracic Fellow) care for a Pediatric Patient during surgery.

8 PAGE 8 DEPARTMENT EXCELLENCE: TEACHER OF TH MONTH NOMINEES! Latha Hebbar, MD, FRCA, FFARCAS(I) The Students of MUSC College of Medicine certify to all that: Dr. Michelle Rovner has been nominated as a Teacher of the Month December Granted: 1/7/12 Amy Turner, Faculty Excellence Co-Chair Michelle Rovner, MD

9 PAGE 9 THREE NEW FACES TO THE DEPARMENT OF ANETHESIA! Bethany Wolf, PhD Biostatistician Bethany joined MUSC s Division of Biostatistics and Epidemiology in 2010 as an assistant professor of Biostatistics. Much of her time is spent collaborating with various clinicians and basic science researchers across the MUSC campus since she is one of the statisticians working in the Biostatistics Core of the South Carolina Clinical and Translation Institute (SCTR). Bethany began her career as a chemist after graduating from Rice University in 1995 with a degree in chemistry and anthropology. After a brief stint as a petroleum engineer, she returned to school for a master s degree. Here she spent much of the master s program out to sea on research vessels, or way down south in New Zealand collecting and analyzing trace metal content in remote marine rain- the goal was to better understand global iron transport and its role in the carbon cycle. After 2+ years she graduated with a master's degree in marine and environmental chemistry from UNC Wilmington in Between 2000 and 2005 Bethany worked for Bayer as a research chemist developing high performance automotive pigments. While working as a research chemist, she was exposed to the power of statistics in conducting more efficient experiments and thus returned to school in 2005, and graduated from MUSC with a Ph.D. in biostatistics in Her research interests focus on biostatistical applications in data mining and exploration with particular interest in identifying high-order interactions among biological markers predictive of health outcomes. When she is not at MUSC, Bethany spends her free time running, reading, and painting (when she is feeling creative). She also enjoys doing half marathons though recently has branched out to small off road triathlons. Bethany has also painted murals in several rooms in my house, though the largest one has been a work in progress since she first came to MUSC in Chinyere Rumph Radiology Tech, Pain Clinic Chinyere ( C ) is a transplant from Florida in She attended Florida State University and received her Radiology Technologist degree from Keiser University in Tallahassee, Florida. C and her husband have three boys, age 13, 5, and 2. In her spare time, she loves sports (especially football and basketball), traveling, and a good old fashion cookout. C is currently attending Orangeburg Calhoun Technical College online for her Computed Tomography Certification. She is happy to be a part of the Pain Management team at Rutledge Tower! Stacey Newcomer Administrative Assistant, Pain Clinic Stacey is from the small town of Canton, GA, which is about an hour north of Atlanta. She moved to Charleston in June of Shortly after moving to Charleston, she met fiancé and has enjoyed Charleston ever since. Before coming to MUSC, Stacey worked I the durable medical equipment field for the past six years. She spent 5 of those working for Sleepmed Therapy and the last year and a half at ABC medical. Stacey learned a lot during her tenure in this field, but decided it was time for a change and joined the staff here at MUSC. She is enjoying her time here and everyone she is working with in the Pain Clinic.

10 PAGE 10 MUSC CT DIVISION LEARNS 3D ECHO On January 7, the adult CT division underwent an all day 3D transesophageal echocardiography training session hosted by Phillips. Dr. Stan Shernan who is the Director of Cardiac Anesthesia at the Brigham and Women s Hospital and Professor at Harvard Medical School led the education. Advance 3D image acquisition as well as data set manipulation was taught. REDCAP HITS MUSC CAMPUS! DEPARTMENT OF MEDICINE NEWSLETTER, JANUARY 5, 2012, PAGE 3 The REDCap database is a web-based application that has been designed exclusively to support data capture for research studies. Initiated at Vanderbilt University, the database is growing in popularity throughout the MUSC campus. With a current rate of 927 productions, MUSC is second only to Vanderbilt in the highest rate of REDCap usage (Harvard is third). REDCap offers many benefits for those currently using other data entry systems. REDCap Data is securely stored on MUSC servers requiring no special software and automatically backs up the data inputted. REDCap allows for multiple people to edit data simultaneously, has data validation to reduce data entry errors, and allows you to reuse and share your data collection instruments with other medical professionals. For any programs interested in using this database, the creation process is an easy 4 step process: After your initial meeting with an investigator and staff to discuss your data inputting needs, the staff builds a prototype of the database. The database is then tested and sent for IRB approval. After which the website/database is moved into a production environment and ready to be used to enter data. REDCap is continuously working to increase the efficiency of their application. The latest updates to REDCap merged REDCap and REDCap Survey creating an all-in-one place to manage both databases and surveys. REDCap provides an excellent tool for capturing and manipulating data for varying research needs. More information is available on the Project REDCap website or by contacting them through redcap@musc.edu.

11 PAGE 11 IS THE CHAIRMEN LEAVING HIS BELOVED CLEMSON TIGERS!? If you saw Dr. Reeves wearing a gamecock cap in the OR and peds cath labs recently, do not worry. Dr. Reeves is not changing sides. He lost a bet with Dr. Guldan involving the Clemson vs. USC football game. Fortunately, history is on the side of the TIGERS! SPECIAL COMPETENCE IN BASIC PERIOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY The following faculty have recently passed the Basic PTEeXAM: CONGRATULATIONS!! Eric Bolin, MD Carlee Clark, MD

12 a S LEEPY T IMES P AGE 12 F ACULTY /R ESIDENT A NNUAL B OWLING C OMPETITION : J ANUARY 18, 2012 R ESIDENTS FINALLY END THE F ACULTY W INNING S TREAK! It is with sadness that I announce that the faculty s dominance of the residents in bowling has come to an end. The faculty had enjoyed three consecutive years of victory until a beautiful night at the totally renovated River Lanes in Mt. Pleasant. It was extremely close and required the final ball in the tenth frame for Bennett Cierny to finish with a score of 159 to Larry Fields 152. I congratulate the residents and Bennett for a job well done. The faculty thought that they were going to be victorious when Drs. Ryan Gunselman and Michael Hay arrived with their own bowling balls and special black (Gunselman) and white shoes (Hay). Tom Epperson was in his usual top form and did well with Ryan s special black ball. Ryan on the other hand bowled like Ilka! Next year he has agreed to bring his wife s pink ball. Matt and Leslie have decided to reward Bennett with an extra opportunity to do great cases on Saturdays. Left to right: Residents Jenny Matos, Quiana Scotland, Mark Henry, and Kam Wong Left to right: Drs. Ryan Gunselman, Ilka Theruvath, David Stoll, and Cory Furse. Pictured Left: Residents Abdul Agendy, Trevor Adams, and Matt Elliott Pictured Left: The Winners, Dr. Larry Field and Resident Bennett Cierny. Bennett, with a score of 159 (pictured right) was the top winner of the night!

13 PAGE 13 GRAND ROUNDS FOR MONTH OF FEBRUARY PERIOPERATIVE/PROFESSIONALISM What Does it Mean to be a Perioperative Physician? The Future of Anesthesia February 7, 2012 George Guldan, MD Medical University of South Carolina M&M February 14, 2012 Susan Harvey, MD Medical University of South Carolina Implications of Obesity on Anesthesia Management February 21, 2012 Tod Brown, MD Medical University of South Carolina Leadership and Education, Joanne M. Conroy, MD Lecture on Learning and Leadership February 28, 2012 Richard P. Dutton, MD, MBA University of Maryland

14 PAGE 14 DEPARTMENT OF ANESTHESIA AND PERIOPERATIVE MEDICINE I HUNG THE MOON Don t forget to nominate your co-workers for going Beyond the Call of Duty. I hung the Moon slips are available at the 3rd floor front desk, and may be turned in to Rhonda or Kim. Thanks so much!! Medical University of South Carolina 167 Ashley Avenue Chandled@musc.edu Phone: Fax: C HECK OUT OUR WEBSITE AT: MUSC. EDU/ ANESTHESIA Future Events/Lectures 1/Feb Management of Patients with Fluid and Electrolyte Disturbances. Fluid Management and Transfusion, CA1, Larry Field, MD 6/Feb Debt Management, CA2/3, Nathan Straus, CFP (Commonwealth Financial Group) 7/Feb What does it mean to be a Perioperative Physician? The Future of Anesthesia, Grand Rounds, George Guldan, MD 8/Feb Anesthetic Complications, CA1, Jake Freely, MD 13/Feb Post Anesthesia Recovery, Barash Ch. 55, CA2/3, David Stoll, MD 14/Feb M&M, Susan Harvey, MD 20/Feb Perioperative Cardiac Work up for Non Cardiac Surgery, CA2/3,George Guldan, MD 21/Feb Implications of Obesity on Anesthesia Management, Grand Rounds, Tod Brown, MD 22/Feb Post-anesthesia Care, CA1, Laura Roberts, MD 27/Feb Hemostatic Resuscitation, CA2/3, Richard P. Dutton, MD, MBA (Univ. of Maryland) 28/Feb Leadership and Education, Joanne Conroy, MD Lecture series, Grand Rounds, Richard P. Dutton, MD, MBA (Univ. of Maryland) 29/Feb Cardiopulmonary Resuscitation, CA1, Matt McEvoy, MD Cara Spaulding: Excellent work, consistently performs at a high level. Is very attentive and always has a great attitude! Matt Wilder: A great job stepping up and completing our machine/monitor inventory in addition to performing his regular 2nd shift duties in the main. Thanks! Larry Banks: Outstanding teamwork, Larry is awesome! He helped me tremendously in organizing my mission trip. Thank you! Ryan Nobles, MD: Going above and beyond the call of duty, for staying past call to help 1st start blocks. Resident Graduation: June 22, 2012 Location: Charlestown Landing. Holiday Party: December 1, 2012 Location: Carolina Yacht Club. We Would Love to Hear From You! If you have ideas or would like to contribute to Sleepy Times, the deadline for the March edition will be February 20, 2012.